Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

Abstract

Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

Konno-Rastan procedure in surgical recurrence of congenital aortic stenosis and hypoplastic aortic annulus

“…Aortic stenosis (AS) with hypoplastic aortic annulus (HAA), recurrence after percutaneous treatment, progression to severe heart failure, and its association with significant valve insufficiency make it complex and require timely aortic valve surgery [1][2][3]. The Konno-Rastan (K-R) technique consists of enlarging the aortic ring, and provides an aortic annular area compatible with the current hemodynamic requirement of the patient and its subsequent development [4,5].…”

“…Various case series have shown that the K-R procedure together with aortic valve replacement provides optimal postoperative results with minimal associated mortality rates (< 1%), low mean gradient (< 10 mm Hg), and remission of NYHA IV–III symptoms to I–II [ 1 , 3 , 5 ]. Likewise, the safety of this technique has been highlighted with a survival greater than 85% and without deterioration of ventricular function in a 20-year follow-up (LVEF, 58–62%) [ 1 , 2 , 6 ].…”